Patient- and treatment-specific predictors of genitourinary function after high-dose-rate monotherapy for favorable prostate cancer

Raleigh, David R.; Chang, Albert; Tomlin, Bryan; Cunha, J. Adam M.; Braunstein, Steve; Shinohara, Katsuto; Gottschalk, Alexander; Roach, Mack; Hsu, I‐Chow

doi:10.1016/j.brachy.2015.06.004

Cited by 11 publications

(4 citation statements)

References 36 publications

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“…showed that a higher baseline urinary flow was correlated with lower acute GU toxicity. In another study from the University of California San Francisco, prostate volume, intraprostatic urethral length and increased V100 to the urethra were predictive of worse quality of life scores . In our study, we found a correlation between more significant urinary toxicities with the volume of the prostate receiving 150% of the dose (V150 in cc) and 0.1, 1 and 2cc doses to the bladder wall.…”

Section: Discussionsupporting

confidence: 61%

“…In another study from the University of California San Francisco, prostate volume, intraprostatic urethral length and increased V100 to the urethra were predictive of worse quality of life scores. 24 In our study, we found a correlation between more significant urinary toxicities with the volume of the prostate receiving 150% of the dose (V150 in cc) and 0.1, 1 and 2cc doses to the bladder wall. We were not able to confirm the data from other series showing urethral dose or bladder neck dose correlations with acute genitourinary toxicity.…”

Section: Discussionsupporting

confidence: 53%

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Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

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Introduction: To identify differences in acute urinary and sexual toxicity between a 6-fraction and 2-fraction high-dose-rate brachytherapy monotherapy regimen and correlate dosimetric constraints to short-term toxicity. Methods: A single institution retrospective study of 116 men with prostate cancer treated with HDR monotherapy from 2010 to 2015 was conducted. Eighty-one men had 7.25 Gy 9 6-fractions and 35 men had 13.5 Gy 9 2-fractions. Patients had two CT-planned implants spaced 1-2 weeks apart. Patient baseline characteristics, International Prostate Symptom Scores (IPSS) and Sexual Health Inventory for Men (SHIM) scores were collected pre-treatment and 3, 6 and 12 months post-implantation. Mixed effect modelling was undertaken to compare baseline, 1-6 month and 7-12 month scores between groups. Poisson regression analysis was performed to correlate dosimetric constraints with acute toxicity. Results: There was no difference between baseline and post-implantation IPSS scores between 6-fraction and 2-fraction groups. SHIM scores for men treated with 6-fractions had a steeper decline at 1-6 months, but resolved at 7-12 months. Pre-treatment alpha-blocker use correlated with worse shortterm acute urinary toxicity. Worsened SHIM score correlated with increasing age, diabetes mellitus and androgen-deprivation therapy. In a dosimetric analysis of outcomes, prostate V150 dose and bladder wall (D01.cc, D1cc, D2cc) dose correlated with increased IPSS score. Conclusion: No increased acute genitourinary or sexual dysfunction has been observed in men when transitioning from 6-fraction to 2-fraction HDR monotherapy. A dosimetric correlation was found between the V150 and bladder wall doses for acute urinary toxicity. Future research should continue to standardize and validate dose constraints for prostate HDR monotherapy patients.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionsupporting

confidence: 53%

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Ragab

Banerjee²,

Park

et al. 2017

J Med Imag Rad Onc

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“…As seen in prior studies of prostate SBRT, treatment was well tolerated, with a transient increase in urinary symptoms followed by a relatively quick return to baseline function. Notably, prostatic volume was a significant predictor of acute urinary morbidity in this cohort of patients, similar to patients undergoing brachytherapy [18,19]. No other clinical factors, including patient age, clinical tumor stage, D'Amico risk group stratification, or ADT usage were associated with a worsening in IPSS at 7 d following treatment.…”

Section: Discussionmentioning

confidence: 57%

Predictors of acute urinary symptom flare following stereotactic body radiation therapy (SBRT) in the definitive treatment of localized prostate cancer

Repka

Kole²,

Lee

et al. 2017

Acta Oncologica

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“…Accordingly, trials using brachytherapy boosts show improvement in biochemical control over dose-escalated external beam radiation alone [ 11 , 12 , 13 , 14 ]. However, further dose escalation to the entire prostate using brachytherapy has previously been limited by normal tissue toxicity, particularly urinary toxicity associated with dose to the urethra [ 15 , 16 , 17 ].…”

Section: Purposementioning

confidence: 99%

Phase I study of dose escalation to dominant intraprostatic lesions using high-dose-rate brachytherapy

Chapman¹,

Braunstein²,

Pouliot³

et al. 2018

jcb

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PurposeRadiation dose escalation for prostate cancer improves biochemical control but is limited by toxicity. Magnetic resonance spectroscopic imaging (MRSI) can define dominant intraprostatic lesions (DIL). This phase I study evaluated dose escalation to MRSI-defined DIL using high-dose-rate (HDR) brachytherapy.Material and methodsEnrollment was closed early due to low accrual. Ten patients with prostate cancer (T2a-3b, Gleason 6-9, PSA < 20) underwent pre-treatment MRSI, and eight patients had one to three DIL identified. The eight enrolled patients received external beam radiation therapy to 45 Gy and HDR brachytherapy boost to the prostate of 19 Gy in 2 fractions. MRSI images were registered to planning CT images and DIL dose-escalated up to 150% of prescription dose while maintaining normal tissue constraints. The primary endpoint was genitourinary (GU) toxicity.ResultsThe median total DIL volume was 1.31 ml (range, 0.67-6.33 ml). Median DIL boost was 130% of prescription dose (range, 110-150%). Median urethra V120 was 0.15 ml (range, 0-0.4 ml) and median rectum V75 was 0.74 ml (range, 0.1-1.0 ml). Three patients had acute grade 2 GU toxicity, and two patients had late grade 2 GU toxicity. No patients had grade 2 or higher gastrointestinal toxicity, and no grade 3 or higher toxicities were noted. There were no biochemical failures with median follow-up of 4.9 years (range, 2-8.5 years).ConclusionsDose escalation to MRSI-defined DIL is feasible. Toxicity was low but incompletely assessed due to limited patients’ enrollment.

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Patient- and treatment-specific predictors of genitourinary function after high-dose-rate monotherapy for favorable prostate cancer

Cited by 11 publications

References 36 publications

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Comparison of patient‐reported acute urinary and sexual toxicity scores in a 6‐ versus 2‐fraction course of high‐dose‐rate prostate brachytherapy monotherapy

Predictors of acute urinary symptom flare following stereotactic body radiation therapy (SBRT) in the definitive treatment of localized prostate cancer

Phase I study of dose escalation to dominant intraprostatic lesions using high-dose-rate brachytherapy

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